經尿道攝護腺刮除手術後常見的短期併發症及預測因子

徐易廷¹、薛又仁^1,2、黃建榮¹、蕭毅君¹、賴昱維^1,2、邱文祥^1,2

¹臺北市立聯合醫院仁愛院區 外科部 泌尿科；²國立陽明交通大學 醫學院 泌尿學科

The Predictive Factors of Common Early Complications Following Transurethral Resection of the Prostate

Yi-Ting Hsu¹, Thomas Y. Hsueh^1,2, Andy. C. Huang^1,2, Yi-Chun Hsiao¹, Yu-Wei Lai^1,2,

 Allen W. Chiu^1,2

¹Division of Urology, Department of Surgery, Taipei City Hospital renai Branch, Taipei, Taiwan;

²Department of Urology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan

Purpose: The present study is to investigate the prevalence of common early complications in patients treated with traditional bipolar transurethral resection of the prostate(TURP) and laser prostatectomy. Besides, the length of hospital stay and catheterization duration were compared between different surgical techniques during post-surgery period.

Material and methods: A retrospective study was carried out on male patients who underwent surgery for benign prostatic hyperplasia(BPH). Those who diagnosed of prostate cancer and other genitourinary cancer prior to surgical intervention were excluded. Patients were divided into bipolar TURP, Thulium laser enucleation of prostate(ThuLEP) and green light laser photoselective vaporization of prostate(PVP) groups according to treatments used. Data collection was carried out from January 2015 to October 2021. Baseline characteristics included personal information (age), disease information (comorbidities), and medication use.

Results: A total of 722 males were included in the study. As compared to bipolar TURP, ThuLEP group and green light laser PVP group had lesser postoperative catheterization duration (4.2 ± 3.3 days vs. 3.3 ± 3.0 days vs. 2.9 ± 2.3 days, p < 0.0001), and hospitalization duration (3.7 ± 1.9 days vs. 3.2 ± 2.4 days vs. 2.7 ± 1.6 days, p <0.0001). In a month follow-up, these three groups had comparable rate of early postoperative complications including urinary retention, hemorrhage and urinary tract infection(UTI), while transient urinary incontinence(TUI) occurred more frequently in the green light laser PVP group (15.3% vs. 20.9% vs. 26.6%, p = 0.025). Men over 70 years(odds ratio 1.87, 95% confidence interval(CI) [1.005, 3.481], p = 0.048) were more likely to develop hemorrhage. Duration of catheterization indwelling was a predictive factor on infection.

Conclusions: Laser techniques provide a shorter catheterization time and a shorter hospital stay with a comparable early complication rate. Green light laser PVP was associated with higher rates of TUI. The laser techniques and traditional bipolar TURP both represent a safe and efficacious procedure for benign prostatic hyperplasia.